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Title: Planning the Breast Boost: Comparison of Three Techniques and Evolution of Tumor Bed During Treatment

Abstract

Purpose: To evaluate the accuracy of two clinical techniques for electron boost planning compared with computed tomography (CT)-based planning. Additionally, we evaluated the tumor bed characteristics at whole breast planning and boost planning. Methods and Materials: A total of 30 women underwent tumor bed boost planning within 2 weeks of completing whole breast radiotherapy using three planning techniques: scar-based planning, palpation/clinical-based planning, and CT-based planning. The plans were analyzed for dosimetric coverage of the CT-delineated tumor bed. The cavity visualization score was used to define the CT-delineated tumor bed as well or poorly defined. Results: Scar-based planning resulted in inferior tumor bed coverage compared with CT-based planning, with the minimal dose received by 90% of the target volume >90% in 53% and a geographic miss in 53%. The results of palpation/clinical-based planning were significantly better: 87% and 10% for the minimal dose received by 90% of the target volume >90% and geographic miss, respectively. Of the 30 tumor beds, 16 were poorly defined by the cavity visualization score. Of these 16, 8 were well demarcated by the surgical clips. The evaluation of the 22 well-defined tumor beds revealed similar results. A comparison of the tumor bed volume from the initialmore » planning CT scan to the boost planning CT scan revealed a decrease in size in 77% of cases. The mean decrease in volume was 52%. Conclusion: The results of our study have shown that CT-based planning allows for optimal tumor bed coverage compared with clinical and scar-based approaches. However, in the setting of a poorly visualized cavity on CT without surgical clips, palpation/clinical-based planning can help delineate the appropriate target volumes and is superior to scar-based planning. CT simulation at boost planning could allow for a reduction in the boost volumes.« less

Authors:
 [1];  [1];  [2];  [3]; ;  [1];  [2]
  1. Department of Radiation Oncology, Tufts University, Tufts Medical Center, Boston, MA (United States)
  2. Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI (United States)
  3. Biostatistics Research Center, Tufts University, Tufts Medical Center, Boston, MA (United States)
Publication Date:
OSTI Identifier:
21276823
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 74; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2008.08.051; PII: S0360-3016(08)03511-6; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CAT SCANNING; CAVITIES; MAMMARY GLANDS; NEOPLASMS; PLANNING; RADIATION DOSES; RADIOTHERAPY; SIMULATION; SURGERY; WOMEN

Citation Formats

Hepel, Jaroslaw T, Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI, Evans, Suzanne B, Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI, Hiatt, Jessica R, Price, Lori Lyn, DiPetrillo, Thomas, Wazer, David E, Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI, and MacAusland, Stephanie G. Planning the Breast Boost: Comparison of Three Techniques and Evolution of Tumor Bed During Treatment. United States: N. p., 2009. Web. doi:10.1016/j.ijrobp.2008.08.051.
Hepel, Jaroslaw T, Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI, Evans, Suzanne B, Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI, Hiatt, Jessica R, Price, Lori Lyn, DiPetrillo, Thomas, Wazer, David E, Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI, & MacAusland, Stephanie G. Planning the Breast Boost: Comparison of Three Techniques and Evolution of Tumor Bed During Treatment. United States. https://doi.org/10.1016/j.ijrobp.2008.08.051
Hepel, Jaroslaw T, Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI, Evans, Suzanne B, Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI, Hiatt, Jessica R, Price, Lori Lyn, DiPetrillo, Thomas, Wazer, David E, Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI, and MacAusland, Stephanie G. 2009. "Planning the Breast Boost: Comparison of Three Techniques and Evolution of Tumor Bed During Treatment". United States. https://doi.org/10.1016/j.ijrobp.2008.08.051.
@article{osti_21276823,
title = {Planning the Breast Boost: Comparison of Three Techniques and Evolution of Tumor Bed During Treatment},
author = {Hepel, Jaroslaw T and Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI and Evans, Suzanne B and Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI and Hiatt, Jessica R and Price, Lori Lyn and DiPetrillo, Thomas and Wazer, David E and Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI and MacAusland, Stephanie G},
abstractNote = {Purpose: To evaluate the accuracy of two clinical techniques for electron boost planning compared with computed tomography (CT)-based planning. Additionally, we evaluated the tumor bed characteristics at whole breast planning and boost planning. Methods and Materials: A total of 30 women underwent tumor bed boost planning within 2 weeks of completing whole breast radiotherapy using three planning techniques: scar-based planning, palpation/clinical-based planning, and CT-based planning. The plans were analyzed for dosimetric coverage of the CT-delineated tumor bed. The cavity visualization score was used to define the CT-delineated tumor bed as well or poorly defined. Results: Scar-based planning resulted in inferior tumor bed coverage compared with CT-based planning, with the minimal dose received by 90% of the target volume >90% in 53% and a geographic miss in 53%. The results of palpation/clinical-based planning were significantly better: 87% and 10% for the minimal dose received by 90% of the target volume >90% and geographic miss, respectively. Of the 30 tumor beds, 16 were poorly defined by the cavity visualization score. Of these 16, 8 were well demarcated by the surgical clips. The evaluation of the 22 well-defined tumor beds revealed similar results. A comparison of the tumor bed volume from the initial planning CT scan to the boost planning CT scan revealed a decrease in size in 77% of cases. The mean decrease in volume was 52%. Conclusion: The results of our study have shown that CT-based planning allows for optimal tumor bed coverage compared with clinical and scar-based approaches. However, in the setting of a poorly visualized cavity on CT without surgical clips, palpation/clinical-based planning can help delineate the appropriate target volumes and is superior to scar-based planning. CT simulation at boost planning could allow for a reduction in the boost volumes.},
doi = {10.1016/j.ijrobp.2008.08.051},
url = {https://www.osti.gov/biblio/21276823}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 74,
place = {United States},
year = {Mon Jun 01 00:00:00 EDT 2009},
month = {Mon Jun 01 00:00:00 EDT 2009}
}